The Ups and The Downs

The HITECH Act, What does it mean for me?

Healthcare in America is becoming increasingly complex. Insurance premiums rose at triple the rate of inflation for the years of 2005-2010. Compensation and cost of living increases for the American populous rose only 13 percent (Mary L. Hook, Laura J. Burke, & Judy Murphy, 2009). In addition to rising insurance premiums, Americans are living longer with more health complications. Chronic diseases are incredibly expensive to manage and the United States lags behind other nations in terms of the quality of care received. With these factors in mind, President Obama signed the American Investment and Recovery Act into law in 2009. This act, designed to stimulate the American economy, also included an interesting piece of legislation aimed at improving healthcare quality, improving patient outcomes, and decreasing the cost of healthcare. This act was known as the Health Information Technology for Economic and Clinical Health Act (HITECH).

The HITECH act provides two basic subject categories with definitions and elaboration under each. The first part of the legislation outlines the changes to Health Information Portability and Protection Act (HIPPA). With the increased use of electronic transmission of patient date, the government felt the need to mandate new changes in the enforcement of HIPPA with the goal of increasing compliance. Previously, the HIPPA guidelines had been thought of as guidelines only, with little in the way of punishment or enforcement. Under the HITECH act, each violation of HIPPA results in a mandatory fine rather than the previous investigation only approach (Posa & Terry, 2010).

The second section of the HITECH act is perhaps the most likely to radically change healthcare in America. This section outlines Medicare incentives for developing and deploying a fully integrated Electronic Health Record (EHR). The basic structure of the payment is built on a base of 2 million dollars per hospital per year. In addition to the base amount, the facility will be paid 200 dollars per discharge for discharge number 1,150-23,000 (McLeod, 2009). The only caveat is that the system must be implemented by the year 2015.

Rationale for Legislation

The rationale for electronic health records has been evident since the late 1990’s. However, it is not until recently the researchers have begun to examine the effect of a fully integrated, meaningful use, electronic health record (EHR). This is due in large part to the slow adoption process of American hospitals, as well as technological limitations.

Recent research suggests that implementation and use of a fully integrated EHR would result in significant savings, both in terms of human life, and dollars. One study assessed the potential cost savings (combined efficiency and safety) to be between 142-371 billion dollars (Hillestad et al., 2005). Despite these projected benefits, only around 20 percent of U.S. hospitals utilize a fully integrated EMR. (Mahoney, et. al 2007).

Healthcare would be wise to emulate other industries in its application of technology. In the 1990’s retail, banking, and commodities all began to utilize IT in their day to day operations. In particular, consumers enjoyed this increased efficiency in the retail market, with the introduction of the now ubiquitous bar code. These industries all enjoyed remarkable growth as a result of this technology implementation. (Hillestad, et al., 2005). Healthcare is different than many other industries as the actions or inactions that clinicians take have a direct impact on the health of the human population they serve.

The reduction of human error makes a very strong case for the use of widespread EHR adoption. Computerized physician order entry has been shown to eliminate nearly 200,000 medical errors alone. Patient bar-coded administration in conjunction with an electronic patient medication administration record have been proven to reduce medication errors by nearly 60 percent (Mahoney, et al., 2007). This translates into a substantial financial savings if 90 percent or more of hospitals were fully utilizing an EHR system. In addition to these benefits, providing an electronic health record for patients, will allow them to examine a full longitudinal record of their care (Posa & Terry, 2010).

Legislation Support and Opposition

Support of the HITECH Act has found much support in the area of clinical outcomes research. As stated earlier, the implementation of an electronic health records nationwide would presumably have a positive effect on patient outcomes while simultaneously decreasing overall healthcare costs. The very nature of nature of medical records, specifically the concept of simultaneous user access to a single record, brings up the possibilities of increased privacy violations. The HITECH act addresses this problem by enhancing the enforcement of HIPPPA, as well as laying out a strategic plan for patient notification of health care breeches.

Critics of the HITECH act state that the government has no place in mandating whether or not a healthcare facility uses an EHR or not. In these circles, healthcare is identified as being subject to the same free market principles that apply to any other business (Waldren, Kibbe, & Mitchell, 2009). Adding fuel to this fire is the reality that in 2015, if a facility has not implemented an EHR, than the economic incentive for implementation disappears and is replaced by fines; in the form of a percentage of Medicare reimbursement denials.

Secondly, the government has not clearly articulated what is meant by “meaningful use”. While a 556 page document exists pertaining to these definitions, there still remain significant issues surrounding these guidelines (Murer, 2010). Many in the political and healthcare leadership community question how these standards will be enforced, with no clear answer being given by the government. In addition, the definition of eligibility for Medicare reimbursement leaves out other health care facilities such as Long Term Acute Care facilities (LTAC), and outpatient surgery centers.

Outcome of the Legislation

The outcome of the legislation has yet to be fully determined. This is due in part to the timeline that has been set by the legislation. However, healthcare facilities across the nation have been scrambling to implement a meaningful use EHR. One research estimate states that the recent legislation has increased the amount of EHR adoption by 15% (Whittaker, Aufdenkamp, & Tinley, 2009). This is predicted to increase by at least 10 percent per year up to the cutoff date set by the legislation. The legislation has also increased the demand for clinicians trained in healthcare settings, specifically, nurses (M. L. Hook, L. J. Burke, & J. Murphy, 2009). Nurses are well poised to capitalize on interdisciplinary knowledge, systems thinking, and clinical practice. These attributes are essential to the ongoing evaluation, implementation, and optimization of an EHR. Demand for specially trained informatics professionals is expected to increase substantially in the next 5-10 years.

Impact of Legislation on Nursing Practice

The Health Information Portability and Protection Act (HIPPA) passed in 1996 outlined specific methods that should be followed to ensure the protection of a patients personal health information. However, enforcement remains lax in many settings. Traditionally, the punishment for violations of HIPPA involved nothing more than a “slap on the wrist” a simple investigation into the violation with no actual consequences. With the onset of widespread utilization of electronic medical record exchanges the need for increased scrutiny (due to ease of accessibility) of data exchanges is easily justified. As such, the HITECH act outlines new ways in which protected health information will be seen by those with reason to do so, while providing stiff penalties for violators. In addition to these guidelines, the HITECH act outlines a specific patient information breech protocol. Although the previous HIPPA guidelines stated that the affected individual be notified of the breech, it did not specify how and when to notify individuals (“HITECH Act of 2009 expands privacy and security rules,” 2010). This increased oversight will have a direct impact on the ways in which nurses protect personal health information. Nurses are often the first line of defense against potential breeches in patient security. With the knowledge of the direct consequences that these breeches incur, nursing as a whole should demonstrate increased vigilance in protecting private patient records. The fines are hefty and are classified based on the intent (willful, negligent, or non willful). The maximum fine that a facility can be fined is 50,000 dollars per violation with a 1.5 million dollar yearly maximum (Posa & Terry, 2010). The knowledge of this new fine structure is important for nurses to be aware of as they are often the gatekeepers of patient information.

The second area of HITECH legislation that affects nurses is the government Medicare incentive plans related to meaningful use deployment and utilization of a fully integrated electronic health record system. Nursing has long lagged behind other industries in utilization of electronic systems. The reasons for this are not exactly clear, but the fact remains that hospitals across the nation are scrambling to implement a system that meets standards. With that being said, nurses that do not consider themselves “computer savvy” can take advantage of free or low cost educational offerings to increase their basic computer knowledge. Skills such as mouse movement, keyboarding, and basic functionality are often covered in these courses. Nurses that participate in these courses report feeling much more prepared to be able to navigate and use newer electronic health record systems (Dahm & Wadensten, 2008). Education can assist in demystifying the electronic health record and encourage active participation and widespread adoption.

Summary

Support for the use of the full use of an EHR system is well supported in research. Patient safety as well as operational income is enhanced with the full use of an EHR. The government mandated implementation of such a system comes with issues of its own. Opponents of the legislation claim that it violates what is inherently a free market enterprise. Despite these misgivings, healthcare facilities are quickly attempting to roll out eligible EHR systems. Nurses will be crucial in this adoption, as they make up the backbone of the healthcare industry. Time will tell if this legislation will result in a more stable health care system.

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About joshnurse81

I am an Informatics Nurse currently working on finishing my Master's Degree in nursing Administration. As part of my professional interests, I will be maintaining this blog to keep you up to date on exciting developments in the field of informatics! In addition, I will post my day to day triumphs and tribulations as I navigate this exciting field.